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Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor's professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Over the past decade, the field of urological and male reproductive system pathology has experienced rapid development. Numerous accomplishments were achieved in clinical diagnosis and molecular research in this area in China, gradually gaining international recognition. As the most influential academic journal in the field of pathology in China, the Chinese Journal of Pathology has witnessed the vigorous growth and innovation in this domain. On the occasion of the journal's 70th anniversary, a summary on the developments in this field have been provided, along with an outlook for the future.

Objective: To investigate the clinicopathological features, immunophenotype, molecular characteristics, and differential diagnosis of MED15-TFE3 gene fusion renal cell carcinoma (MED15-TFE3 RCC). Methods: A total of 12 MED15-TFE3 RCCs, diagnosed from 2016 to 2023, were collected from the Department of Pathology of Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China for clinicopathologic, immunohistochemical, fluorescence in situ hybridization (FISH) and RNA sequencing (RNA-seq) analyses and follow-up. In addition, its diagnosis and differential diagnosis were also explored. Results: There were five males and seven females. The patients' ages ranged from 16 to 60 years, with an average age of 40.4 years. The follow-up time ranged from 15 to 92 months, and no recurrence or metastasis was observed. Histologically, 6 cases exhibited extensive cystic structures with almost no solid sheet components, while the remaining 6 cases displayed a cysto-solid growth pattern. The cytoplasm of the tumor cells appeared flocculent, with a clear or faintly eosinophilic appearance, and nucleoli were inconspicuous. Psammoma bodies were observed in 12 cases. There was deposition of basement membrane-like material in 5 cases. All cases showed strong expression of TFE3, GPNMB, Cathepsin K, Melan A, and PAX8, while no expression of CAⅨ or CK7. FISH analyses showed that all 12 cases were positive for the MED15-TFE3 fusion, while the MED15-TFE3 fusion gene and specific fusion sites were detected in 2 cases using RNA-seq. Conclusions: MED15-TFE3 RCC is a type of TFE3-rearranged renal cell carcinoma that exhibits both identifiable diagnostic characteristics and highly deceptive morphology. Its distinct extensive cystic structure can be easily confused with multilocular cystic renal neoplasm of low malignant potential, necessitating careful differentiation in routine practice.

A widespread concern had been there regarding soil ecological and environmental problems caused by microplastic pollution in agricultural soils. A controlled laboratory incubation experiment was performed to examine the effects of different types of microplastics on soil properties, N 2 O emissions, and nitrogen （N） transformations in tropical arable soils from a pepper-corn cropping system in Hainan Province. Three treatments were done： soil without microplastics （CK） and soil amended with 5% of polyethylene （PE） or with 5% of polybutylene adipate co-terephthalate （PBAT）. The results showed that both types of microplastic addition increased soil pH, soil organic carbon （SOC）, and dissolved organic carbon （DOC） contents, with stronger treatment effects observed for PBAT than those for the PE treatment. In addition, the PE and PBAT treatments increased soil ammonium nitrogen （NH 4 + -N） contents by 66.07% and 119.65% and decreased nitrate nitrogen （NO 3 - -N） contents by 8.56% and 29.68%, respectively. Compared to those in the CK treatment, the addition of PBAT significantly increased soil N 2 O emissions by 254.92% （ P < 0.05）, whereas that of PE produced no significant effects. Furthermore, both the PE and PBAT treatments increased soil net nitrogen mineralization rate （NMR） and decreased soil net nitrification rate （NNR）, with more obvious treatment effects observed in PBAT than in the PE treatment. PBAT addition increased the abundance of ureC , while PE had no significant effects. Microplastic addition reduced the abundance of nitrifying gene abundances （AOA- amoA , AOB- amoA , and nxrA ）, with more obvious treatment effects found in the PBAT treatment. Further, PBAT addition significantly increased the gene abundances of nirK , nirS , nosZ , and fungal nirK （ P < 0.05）, whereas the addition of PE had no significant effect on those gene abundances. Soil N 2 O emissions had positive relationships with NH 4 + -N intensity, pH, DOC, SOC, and nirS abundance. In conclusion, biodegradable microplastics addition produced stronger influences on soil properties and N transformations than the non-biodegradable one in tropical arable soils and aggravated soil N 2 O emissions mainly by promoting denitrification.

This study employed network pharmacology, molecular docking, and animal experiments to investigate the mechanism of ginger-processed Anemarrhenae Rhizoma in treating cough due to cold and dampness in lung, aiming to provide a modern pharmacological basis for this therapy. The active ingredients of ginger-processed Anemarrhenae Rhizoma were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP) with the oral bioavailability(OB≥30%) and drug likeness(DL≥0.18) as the screening conditions and from the relevant literature. A library of the active ingredients of ginger-processed Anemarrhenae Rhizoma was established, and SwissTargetPrediction was used to predict the potential targets of the active ingredients. The western medical symptom corresponding to cough due to cold and dampness in lung was identified as acute bronchitis based on SymMap, and the targets related to acute bronchitis were obtained from GeneCards, and the Online Mendelian Inheritance in Man(OMIM). Venny was utilized to obtain the common targets between the active ingredients and the disease, and STRING and Cytoscape were used to establish the protein-protein interaction(PPI) network for the common targets. The Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analyses of potential therapeutic targets were performed with DAVID. AutoDock was used to simulate the molecular docking between the active ingredients with potential targets. Finally, a mouse model of acute bronchitis was prepared with the smoke plus cold stimulation method for validation. In this study, a total of 557 potential targets of the active ingredients of ginger-processed Anemarrhenae Rhizoma were retrieved, including 157 common targets shared with acute bronchitis. The enrichment analysis yielded 1 072 GO terms and 169 KEGG pathways. The results of molecular docking showed that the active ingredients had good binding affinity with MAPK14 and MMP3, and timosaponin AⅢ showcased the strongest binding affinity among the active ingredients. In the animal experiments, other treatment groups except the low-and high-dose raw Anemarrhenae Rhizoma and the ginger decoction groups showed reduced pathological changes in the lung tissue, attenuated inflammatory cell infiltration, lowered levels of interleukin(IL)-1β, IL-18, and tumor necrosis factor(TNF)-α in the bronchoalveolar lavage fluid(BALF), and down-regulated mRNA and protein levels of MAPK14 and MMP3 in the lung tissue. Moreover, ginger-processed Anemarrhenae Rhizoma outperformed raw Anemarrhenae Rhizoma. This study preliminarily revealed that ginger-processed Anemarrhenae Rhizoma can inhibit inflammation by regulating the IL-17, TNF, and other signaling pathways to treat cough due to cold and dampness in lung, verifying the rationality of this therapy. The findings provide a basis for the inheritance and application of the characteristic ginger processing of Anemarrhenae Rhizoma.

Objective: To summarize and analyze the clinical characteristics and prognosis of thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). Methods: A retrospective analysis was conducted on the clinical data of 51 patients with SMARCA4-UT who were diagnosed in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2023, and 52 patients with SMARCA4-intact non-small cell lung cancer (SMARCA4-iNSCLC) expression admitted during the same period were used as controls. The Kaplan-Meier survival analysis and log-rank test were used to analyze the survival difference between the two groups of patients, and the Cox regression model was used to explore the factors influencing the prognosis of the two groups of patients. Results: In the SMARCA4-UT group, there were 50 males and 1 female, with the age of (63.8±9.7) years. Compared to the SMARCA4-iNSCLC group, the SMARCA4-UT group exhibited a higher proportion of male patients and smokers, as well as a higher Ki-67 level (all P <0.05). SMARCA4-UT is mainly characterized by solid lesions with poor adhesion, and some of them exhibit rhabdomyoid morphology. Immunohistochemistry revealed negative results for BRG1, thyroid transcription factor-1, P40, NapsinA, and others were mostly negative, while some patients were positive for spalt-like transcription factor 4. There were a relatively large number of cases with Ki-67≥30% (47/51, 92%). Among the 10 patients in the SMARCA4-UT group who underwent next-generation sequencing genetic testing, 6 patients were found to have SMARCA4 mutations, often accompanied by TP53 (8/10, 80%), STK 11(3/10, 30%), KRAS(2/10, 20%), with fewer common driver gene mutations. The average tumor mutation burden was 16.12 mutations/Mb. Compared with SMARCA4-iNSCLC patients, the median overall survival of SMARCA4-UT patients was significantly shorter (12 months vs 45 months, P <0.001), and the median overall survival of patients with stage Ⅲ-Ⅳ SMARCA4-UT treated with immunotherapy was longer than that of patients without immunotherapy (23 months vs 7 months, P =0.027). The results of the multivariate Cox regression model analysis indicated that SMARCA4 deficiency is a risk factor for prognosis in patients with SMARCA4-UT and SMARCA4-iNSCLC [ HR =7.954(95% CI： 2.764-22.890), P <0.001]. Conclusions: SMARCA4-UT is a rare undifferentiated tumour distinct from SMARCA4-iNSCLC, which is prevalent among elderly male smokers. It possesses high invasiveness and poor prognosis. The typical pathological characteristic is negative BRG1. Immunotherapy demonstrates a certain effect.

The aim of this study was to investigate whether the protective effect of 2-deoxyglucose (2-DG) on lung ischemia/reperfusion (I/R) injury is mediated by inhibiting nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3)-mediated pyroptosis in rats. Male Sprague-Dawley rats were randomly divided into control group, 2-DG group, lung I/R injury group (I/R group) and 2-DG+I/R group. 2-DG (0.7 g/kg) was intraperitoneally injected 1 h prior to lung ischemia. The tissue structure was measured under light microscope. Lung injury parameters were detected. The contents of malondialdehyde (MDA), myeloperoxidase (MPO) and lactate were determined by commercially available kits. ELISA was used to detect the levels of IL-1β and IL-18. Western blot, qRT-PCR and immunofluorescence staining were used to measure the expression changes of glycolysis and pyroptosis related indicators. The results showed that there was no significant difference in the parameters between the control group and the 2-DG group. However, the lung injury parameters, oxidative stress response, lactic acid content, IL-1β, and IL-18 levels were significantly increased in the I/R group. The protein expression levels of glycolysis and pyroptosis related indicators including hexokinase 2 (HK2), pyruvate kinase 2 (PKM2), NLRP3, Gasdermin superfamily member GSDMD-N, cleaved-Caspase1, cleaved-IL-1β and cleaved-IL-18, and the gene expression levels of HK2, PKM2 and NLRP3 were markedly up-regulated in the I/R group compared with those in the control group. The expression of HK2 and NLRP3 was also increased detected by immunofluorescence staining. Compared with the I/R group, the 2-DG+I/R group exhibited significantly improved alveolar structure and inflammatory infiltration, reduced lung injury parameters, and decreased expression of glycolysis and pyroptosis related indicators. These results suggest that 2-DG protects against lung I/R injury possibly by inhibiting NLRP3-mediated pyroptosis in rats.

The purpose of the study was to investigate the mechanism of TFEB activator 1 (TA1) improving the autophagic degradation of oligomeric amyloid-β (oAβ) in microglia, and to explore the therapeutic effect of TA1 on an in vitro model of microglia in Alzheimer's disease (AD). Primary microglia were exposed to 1 μmol/L oAβ for 0, 3, 12, and 24 h respectively to construct the in vitro model of microglia in AD. In order to explore the therapeutic effect of TA1, primary microglia were co-treated with 1 μmol/L oAβ and 1 μmol/L TA1 for 12 h. To determine the autophagy flux, the above cells were further treated with 100 nmol/L Bafilomycin A1 for 1 h before fixation. Fluorescent probes were used to detect the endocytosis or degradation of oAβ 1-42 by microglia. The autophagic flux was determined by infection of lentivirus mCherry-EGFP-LC3. The nuclear TFEB intensity, the autophagosomes number, and the colocalization ratio of oAβ 1-42 with lysosome-associated membrane protein 1 (LAMP1) or microtubule-associated protein light chain 3 (LC3), were detected by immunofluorescence assay. Expressions of autophagy-related-genes, including Lamp1, Atg5, and Map1lc3b, were detected by qRT-PCR. Results showed that prolonged oAβ exposure inhibited the endocytosis and degradation of oAβ by microglia. Meanwhile, the number of autophagosomes and autophagy flux in microglia decreased after 12 h of oAβ treatment. We further found that the nuclear expression of autophagy regulator TFEB decreased after 12 h of oAβ exposure, resulting in the decrease of autophagy genes, thus leading to the damage of autophagic degradation of oAβ. Therefore, long-term oAβ exposure was considered to construct the in vitro model of microglia in AD. After TA1 treatment, the nuclear expression of TFEB in cells was obviously upregulated. TA1 treatment upregulated the expressions of autophagy-related genes, leading to the recovery of autophagy flux. TA1 also recovered the endocytosis and degradation of oAβ by microglia. In conclusion, TA1 could improve oAβ clearance by microglia in AD by upregulating microglial TFEB-mediated autophagy, suggesting TA1 as a potential therapeutic drug for AD.

Objective: This study aimed to compare the audiological characteristics between children with unilateral auditory neuropathy (UAN) and single-sided deafness (SSD) to establish a valid basis for the differential diagnosis of children with UAN. Methods: A retrospective analysis was conducted on audiological and imaging evaluations of children with UAN and SSD who were treated at Beijing Children's Hospital of Capital Medical University between May 2015 and June 2023. There were 17 children with UAN, comprising 10 males and 7 females, with an average age of 4.7 years. Additionally, there were 43 children with SSD, consisting of 27 males and 16 females, with an average age of 6.5 years. Audiological assessments included Auditory brainstem response (ABR), Steady-state auditory evoked potential (ASSR), Behavioural audiometry, Cochlear microphonic potential (CM), Distortino-product otoacoustic emission (DPOAE), and acoustic immittance test. The results of the audiological assessment and imaging phenotypic between the two groups of children were compared and analyzed by applying SPSS 27.0 statistical software. Results: (1) The UAN group (77.8%) had a significantly higher rate of ABR wave III L than the SSD group (20.9%) ( P <0.01). The PA thresholds at 500 Hz and 1 000 Hz of children with SSD were higher than those of children with UAN, while the ASSR thresholds at 500 Hz, 1000 Hz, 2 000 Hz, and 4 000 Hz of children with SSD were significantly higher than those of children with UAN ( P <0.05). (2) The degree of hearing loss in both UAN and SSD children was predominantly complete hearing loss. The percentage of complete hearing loss was significantly higher (χ²=4.353, P =0.037) in the SSD group (93.0%, 40/43) than in the UAN group (63.6%, 7/11). However, the percentage of profound hearing loss was significantly higher in the UAN group (27.3%, 3/11) than in the SSD group (2.3%, 1/43) ( Fisher's exact test, P= 0.023). In terms of hearing curve configuration, the percentage of flat type was significantly higher in the SSD group (76.7%, 33/43) than in the UAN group (36.4%, 4/11). The proportion of the UAN group (27.3%, 3/11) was significantly higher than that in the SSD group (2.3%, 1/43) in ascending type ( P <0.05). There were no statistically significant differences in the hearing curves of the declining type and other types between the two groups ( P >0.05). (3) The proportion of imaging assessment without abnormality was significantly more common in the UAN group (81.8%) than in the SSD group (37.1%) (χ²=6.695, P =0.015). Conclusions: Compared to children with SSD, the occurrence of wave III L on the ABR test was significantly more common in children with UAN. The percentage of ascending hearing curves was significantly higher in children with UAN than in children with SSD. ASSR thresholds were significantly lower in children with UAN. The normal imaging phenotype was significantly more common in children with UAN than in children with SSD.

The evolution of critical care medicine is inextricably linked to the development of critical care procedures. These procedures not only facilitate diagnosis and treatment of critically ill patients, but also provide valuable insights into disease pathophysiology. While critical care interventions offer undeniable benefits, the potential for iatrogenic complications necessitates careful consideration. The recent surge in critical care ultrasound (US) utilization is a testament to its unique advantages: non-invasiveness, real-time bedside availability, direct visualization of internal structures, elimination of ionizing radiation exposure, repeatability, and relative ease of learning. Recognizing the need to optimize procedures and minimize complications, critical care utrasound study group of Beijing critical care ultrasound research assocition convened a panel of critical care experts to generate this consensus statement. This document serves as a guide for healthcare providers, aiming to ensure patient safety and best practices in critical care.

Amphotericin B (AmB) is a polyene-macrolide antimicrobial drug with a broad antibacterial spectrum and remarkable efficacy against deep fungal infections. It binds to ergosterol on the fungal cell membrane and alters its permeability, thereby destroying the membrane. AmB is a multicomponent antimicrobial medication that contains a wide range of impurities, rendering quality analysis extremely difficult. In the current Chinese Pharmacopoeia (Edition 2020) and European Pharmacopoeia (EP10.3), high performance liquid chromatography (HPLC) is applied to examine related substances in AmB. However, this technique presents a number of issues. For instance, the mobile phases used in the HPLC method described in both references contain nonvolatile inorganic salts, which cannot be coupled with a mass spectrometry (MS) detector. In addition, because the mobile phases used have a low pH, the component/impurities of AmB drug can easily be degraded or interconverted during the analytical process, leading to reduced analytical accuracy. Therefore, the accuracy and sensitivity of this method must be improved. In this study, a method based on on-line two-dimensional high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (2D HPLC-Q TOF/MS) was developed to analyze the impurity profile of AmB in accordance with the Chinese Pharmacopoeia (Edition 2020) and European Pharmacopoeia (EP10.3). The method combines on-line dilution and a multiple-capture HPLC system to achieve the efficient separation of AmB component/impurities. It also resolves the issue of poor solvent compatibility in 2D HPLC, increases the analytical flux, enhances the automation capability, reduces the mutual conversion of AmB and its impurities during the analytical process, and increases the detection sensitivity of the method. MS was also used to determine the structural inference of unstable components and impurities. An XBridge Shield C18 column (250 mm×4.6 mm, 3 μm) was used for first-dimensional-liquid chromatography with gradient elution using methanol-acetonitrile-4.2 g/L citric acid monohydrate solution (10∶30∶60, v/v/v, pH 4.7) as mobile phase A and methanol-acetonitrile-4.2 g/L citric acid monohydrate solution (12∶68∶20, v/v/v, pH 3.9) as mobile phase B. An Xtimate C8 column (10 mm×2.1 mm, 5 μm) was used as the trap column, and trapping and desalting were performed using 10 mmol/L ammonium formate aqueous solution containing 0.1% formic acid-acetonitrile (95∶5, v/v). An Xtimate C8 column (250 mm×2.1 mm, 5 μm) was used for second-dimensional-liquid chromatography with gradient elution using 10 mmol/L ammonium formate aqueous solution containing 0.1% formic acid-acetonitrile (95∶5, v/v) and 10 mmol/L ammonium formate aqueous solution containing 0.1% formic acid-acetonitrile (5∶95, v/v) as mobile phases. The data were collected in positive-ion mode. In this study, the structures of six impurities in amphotericin B were inferred, according to the fragmentation, the MS and MS 2 spectra of each impurity. The developed method can be used to quickly and sensitively analyze the impurity profile of AmB. Furthermore, the research results on impurity profiles can be applied to guide improvements in AmB production.

Quantifying the risk of soil heavy metal sources can identify the main pollution sources. It can provide a scientific basis for reducing the ecological and human health risks of soil heavy metals. Taking the shallow soil in a Pb-Zn mine watershed in northern Guangxi as a research object， ecological and human health risk assessments were conducted using potential ecological risk assessment （RI） and human health risk assessment （HRA）， and the source apportionment of soil heavy metals was completed using the absolute principal component-multiple linear regression receptor （APCS-MLR） model and random forest （RF） model. Then， a combined risk assessment model， consisting of RI， HRA， and APCS-MLR， was used to quantify the risk of soil heavy metal sources. The results showed that the contents of Pb， Zn， Cu， and Cd exceeded the environmental screening values for agricultural land with mean values of 342.77， 693.34， 61.27， and 3.08 mg·kg -1 ， respectively， and there was a certain degree of contamination. Pb， Cr， and As were the main health risk impact factors， with higher health risks for children than for adults. Three sources were identified： mining activities （Source Ⅰ）， soil parent material sources and original formation （Source Ⅱ）， and unknown sources. Pb， Zn， Cu， and Cd were mainly derived from Source Ⅰ， and Cr and As were controlled by unknown sources and Source Ⅱ. The source risk assessment results of soil heavy metals indicated that the potential ecological risk and non-carcinogenic risk were mainly from Source Ⅰ and Source Ⅱ， and carcinogenic risk was mainly from unknown sources. The unknown sources had a high proportion in source apportionment and risk assessment， and should be further researched to provide scientific basis for soil heavy metal control. The combined risk assessment model based on source analysis， focusing on the risk characteristics of different sources， can accurately identify high-risk pollution sources. It is a more reasonable and reliable risk assessment method.

Objective: To establish an evaluation model for occupational hazard prevention and control levels in coal mines, to explore the combination of Analytic Hierarchy Process (AHP) and fuzzy comprehensive evaluation, to evaluate the overall situation of occupational hazard prevention and control in coal mines. Methods: In November 2021, Collect information of occupational hazards and their prevention and control status in 30 coal mines. AHP model was first constructed for the elements of occupational hazard prevention and control in coal mines. Then, the AHP and fuzzy comprehensive evaluation method was applied to comprehensively evaluate and grade the occupational hazard prevention and control in coal mines, using the principles of maximum membership and weighted average. Results: The hierarchical fuzzy comprehensive evaluation results for typical coal mine were basically consistent with its occupational hazard prevention and control situation. The dust prevention and control situation was good, the noise prevention and control situation is average, the occupational health monitoring situation was good, the occupational health management situation was average, and the overall level of occupational hazard prevention and control was good. Conclusion: The hierarchical fuzzy comprehensive evaluation model for occupational hazard prevention and control levels, combined with the principles of maximum membership and weighted average, can objectively evaluate and reflect the overall situation of occupational hazard prevention and control in coal mines.

Acute respiratory and circulatory disorders are the most common critical syndromes, the essence of which is damage to the organs/systems of the heart and lungs. These comprise the essential manifestation of disease and injury progression to the severe stage. Its development involves the following components: individual specificity, primary disease strike, dysregulation of the host's response, and systemic disorders. Admission for acute respiratory and circulatory disorders is a clinical challenge. Based on a previously proposed flow, a critical care ultrasound-based stepwise approach (PIEPEAR) as a standard procedure to manage patients with acute cardiorespiratory compromise and practical experience in recent years, a modified seven-step analysis and treatment process has been developed to help guide clinicians with rational thinking and standardized treatment when faced with acute respiratory and circulatory disorders. The process consists of seven steps: problem-based clinical analysis, intentional information acquisition, evaluation of core disorder based on critical care ultrasound, pathophysiology and host response phenotype identification, etiology diagnosis, act treatment through pathophysiology-host response and etiology, and re-check. The modified seven-step approach is guided by a "modular analysis" style of thinking and visual monitoring. This approach can strengthen the identification of clinical problems and facilitate a three-in-one analysis. It focuses on pathophysiological disorders, body reactions, and primary causes to more accurately understand the condition's key points, and make treatment more straight forward, to finally achieve the aim of "comprehensive cognition and refined treatment".

Taking a typical lead-zinc mining area watershed in northern Guangxi as the research object, the total amount and morphology of nine heavy metals(Zn, Pb, Cd, Fe, Mn, Cu, Cr, Sb, and As) and fine soil property indicators(pH, conductivity, cation exchange, organic matter, and particle size) in the surface soils of the Yangshuo lead-zinc mine were analyzed and determined. The accumulation and distribution of soil heavy metals and their main controlling factors were revealed using correlation, redundancy(RDA), and GeoDetector analyses. In the analytical data of soil samples, the mean values of As, Cd, Fe, Cu, Mn, Pb, and Zn exceeded the background values, in which Cd, Mn, Pb, and Zn were 4.01, 3.15, 5.53, and 9.72 times higher than the background values, respectively, indicating that they were significantly enriched in the surface soil. There were more noticeable spatial differences in distribution, which were higher in the alluvial floodplain accumulation area(1-6) than those in the other areas(7-9). The available states( K ) of Pb and Mn were 48.8% and 57.2%, respectively, with high bioavailability and average potential migration capacity(PMI 0.015-0.068 and 0.036-0.082, respectively). The Zn and Cu had some bioavailability degree, with available states( K ) of 30.9% and 16.8% and moderately available states of 10.9% and 13.6%, respectively. The difference was that Zn had a strong migration capacity(PMI 0.160-0.203), and Cu had an average potential migration capacity(PMI 0.017-0.084). Fe and Cr had a difficult-to-use state( N )>95%, low bioavailability, and weak migration capacity(PMI<0.005). The results of the analysis of the main controlling factors affecting accumulation and distribution showed that Cr was controlled by cation exchange capacity(CEC) and clay; Fe was controlled by sand; As was controlled by electrical conductivity(EC) and pH; Cu, Zn, Cd, and Sb were controlled by pH and clay; Pb accumulation was controlled by pH and soil organic matter(SOM); Mn was controlled by pH. This study quantified the main controlling factors affecting the accumulation and distribution of soil heavy metals, which can provide a scientific basis for decision making in the prevention and control of soil heavy metal pollution.

In this study, we investigated the effects of Panax notoginseng saponins (PNS) on pulmonary vascular remodeling and ADAM10/Notch3 pathway in pulmonary arterial hypertension (PAH). PAH rat model was established, and male Sprague Dawley (SD) rats were randomly divided into control group, monocrotaline (MCT) group and MCT+PNS group, with 10 rats in each group. Rats in the control group were intraperitoneally injected with equal volume of normal saline. Rats in the MCT group was injected intraperitoneally with 60 mg/kg MCT on the first day, and then with the same volume of normal saline every day. Rats in the MCT+PNS group was injected intraperitoneally with 60 mg/kg MCT on the first day, and then with 50 mg/kg PNS every day. The modeling time of each group lasted for 21 days. After the model was established, the mean pulmonary artery pressure (mPAP) was measured by right heart catheterization technique, the right ventricular hypertrophy index (RVHI) was calculated, the microscopic morphology and changes of pulmonary vascular wall were observed by HE and Masson staining, and the expressions of ADAM10, Notch3, Hes-1, P27, PCNA, Caspase-3 proteins and mRNA in pulmonary vascular tissue of rats were detected by Western blot and qPCR. The expression and localization of Notch3 and α-SMA were detected by immunofluorescence staining. The protein expression of ADAM10 was detected by immunohistochemical staining. The results showed that compared with the control group, mPAP, RVHI, pulmonary vessels and collagen fibers in the MCT group were significantly increased, the expressions of ADAM10, Notch3, Hes-1, and PCNA protein and mRNA were significantly increased, while the expressions of P27 and Caspase-3 protein and mRNA were decreased significantly. Compared with the MCT group, mPAP and RVHI were significantly decreased, pulmonary vessels were significantly improved and collagen fibers were significantly reduced, the expressions of protein and mRNA of ADAM10, Notch3, Hes-1, and PCNA were decreased in MCT+PNS group, but the expressions of protein and mRNA of P27 and Caspase-3 were increased slightly. The results of immunofluorescence showed that Notch3 and α-SMA staining could overlap, which proved that Notch3 was expressed in smooth muscle cells. The expression of Notch3 in the MCT group was increased significantly compared with that in the control group, while PNS intervention decreased the expression of Notch3. Immunohistochemical staining showed that compared with the control group, the amount of ADAM10 in the MCT group was increased significantly, and the expression of ADAM10 in the MCT+PNS group was decreased compared with the MCT group. These results indicate that PNS can improve the PAH induced by MCT in rats by inhibiting ADAM10/Notch3 signaling pathway.

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

The widespread and frequent use of antibiotics to treat diseases or encourage animal growth has resulted in their persistence and accumulation in water, soil, and sediments. As a typical emerging pollutant in the environment, antibiotics have become an important research focus in recent years. Antibiotics are commonly found at trace levels in water environments. Unfortunately, the determination of various types of antibiotics, all of which exhibit different physicochemical properties, remains a challenging endeavor. Thus, developing pretreatment and analytical techniques to achieve the rapid, sensitive, and accurate analysis of these emerging contaminants in various water samples is an essential undertaking.In this paper, a solid phase extraction-high performance liquid chromatography-tandem mass spectrometry (SPE-HPLC-MS/MS) method for the simultaneous determination of 22 antibiotics including 4 penicillins, 12 quinolones and 6 macrolides in environmental water samples was developed. Based on the characteristics of the screened antibiotics and sample matrix, the pretreatment method was optimized, focusing on the SPE column, pH of the water sample, and amount of ethylene diamine tetra-acetic acid disodium (Na 2 EDTA) added to the water sample. Prior to extraction, a 200 mL water sample was added with 0.5 g of Na 2 EDTA and pH-adjusted to 3 using sulfuric acid or sodium hydroxide solution. Water sample enrichment and purification were achieved using an HLB column. HPLC separation was carried out on a C 18 column (100 mm×2.1 mm, 3.5 μm) via gradient elution with a mobile phase composed of acetonitrile and 0.15% (v/v) formic acid aqueous solution. Qualitative and quantitative analyses were performed on a triple quadrupole mass spectrometer in multiple reaction monitoring mode using an electrospray ionization source. The results showed correlation coefficients greater than 0.995, indicating good linear relationships. The method detection limits (MDLs) and limits of quantification (LOQs) were in the ranges of 2.3-10.7 ng/L and 9.2-42.8 ng/L, respectively. The recoveries of target compounds in surface water at three spiked levels ranged from 61.2% to 157%, with relative standard deviations (RSDs) of 1.0%-21.9%. The recoveries of target compounds in wastewater at three spiked levels were 50.1%-129%, with RSDs of 1.2%-16.9%. The method was successfully applied to the simultaneous determination of antibiotics in reservoir water, surface water, sewage treatment plant outfall, and livestock wastewater. Most of the antibiotics were detected in watershed and livestock wastewater. Lincomycin was detected in 10 surface water samples, with a detection frequency of 90%, and ofloxacin showed the highest contents (127 ng/L) in livestock wastewater. Therefore, the present method exhibits excellent performance in terms of MDLs and recoveries compared with previously reported methods. The developed method presents the advantages of small water sample volumes, wide applicability, and fast analysis times; thus, it can be considered a rapid, efficient, and sensitive analytical method with excellent potential for monitoring emergency environmental pollution. The method could also provide a reliable reference for formulating antibiotic residue standards. The results provide strong support for and an improved understanding of the environmental occurrence, treatment, and control of emerging pollutants.

Objective: To explore the relationship between left ventricular artery coupling and left ventricular work in patients with septic shock, and further clarified their predictive value for the prognosis of septic shock. Methods: In total, 56 patients with septic shock admitted in the Department of Critical Care Medicine of Peking Union Medical College Hospital were retrospectively enrolled between January 2016 and July 2021. The hemodynamic indexes and clinical data monitored by pulse indicator continuous cardiac output (PICCO) at different time points were collected. To reveal alterations of arterial elastance index (EaI), end-systolic elastance index (EesI), EaI/EesI, stroke work (SW), total cardiac function (PVA), and left ventricular ejection efficiency (LVEf) in patients with septic shock at different time points. The patients were divided into the death group ( n =20) and survival group ( n =36) according to the outcome of the ICU. The relationship between left ventricular work and left ventricular arterial coupling and its prognostic value were statistically analyzed. Results: A total of 56 patients were enrolled, 32 males and 24 females, aged (61±15) years. There was a significantly difference in EaI/EesI and LVEf between survivors and non-survivors with septic shock at 6 h ( P <0.05). Further analysis showed that the correlation between EaI/EesI and LVEf was most evident at 6 h after intervention. EaI/EesI was negatively correlated with SW ( r s =-0.500, P <0.001), and highly negative with LVEf ( r s =-0.959, P <0.001). Both univariate logistic regression and multivariate regression analysis showed that EaI/EesI (adjusted OR =42.783, 95% CI : 2.725-671.819, P =0.008) and LVEf (adjusted OR =2.293, 95% CI :1.222-4.301, P =0.010) were risk factors for ICU prognosis of patients with septic shock. The receiver operating characteristic (ROC) curve analysis showed that EaI/EesI [area under the curve (AUC)=0.742±0.083, P =0.004; cut-off value 6.10, sensitivity 88.9%, specificity 65.0%] and LVEf (AUC=0.733±0.084, P =0.006; cut-off value 0.24, sensitivity 88.8%, specificity 60.0%) were both effective indicators for predicting the prognosis of patients with septic shock in the ICU. Moreover, EaI/EesI had a better prognosis value than LVEf (ΔAUC=0.120, Z =6.528, P =0.036). Conclusion: It's indicated that EaI/EesI was significantly correlated with SW and LVEf after 6 h of septic shock intervention; EaI/EesI and LVEf are risk factors and effective predictors of ICU prognosis in patients with septic shock. The predictive efficacy of EaI/EesI is greater than LVEF.

Objective: To investigate the effects of panax notoginseng saponins (PNS) on pulmonary vascular remodeling and SIRT1/FOXO3a/p27 pathway in pulmonary arterial hypertension (PAH) rats. Methods: Male SD rats weighing 200~250g were randomly divided into control group, monocrotaline group (MCT) and monocrotaline + panax notoginseng saponins group (MCT+PNS), with 10 rats in each group. The rats in control group were injected intraperitoneally with normal saline 3 ml/kg on the first day, then injected intraperitoneally with normal saline 2.5 ml/kg every day. The rats in MCT group were injected intraperitoneally with MCT 60 mg/kg on the first day, followed by daily injection of normal saline 2.5 ml/kg. In MCT+PNS group, 60 mg/kg MCT was injected intraperitoneally on the first day, and 50 mg/kg PNS was injected intraperitoneally every day. The above models were fed conventionally for 4 weeks. After the modeling was completed, the mean pulmonary artery pressure (mPAP) and right ventricular systolic pressure (RVSP) of rats in each group were detected by right heart catheter method, weighed and calculated right ventricular hypertrophy index (RVHI), and the pulmonary vascular structure and morphological changes were observed by HE and Masson staining. The protein and gene expressions of SIRT1, FOXO3a, p27, PCNA and Caspase-3 were detected by qPCR and Western blot. Results: Compared with control group, mPAP, RVSP and RVHI in MCT group were increased significantly ( P ＜0.01), pulmonary vessels were thickened significantly and collagen fibers were increased, protein and gene expressions of SIRT1, FOXO3a, p27 and Caspase-3 were decreased ( P ＜0.05 or P ＜0.01). The protein and gene expressions of PCNA were increased ( P ＜0.05). Compared with MCT group, the levels of mPAP, RVSP and RVHI in MCT+PNS group were decreased significantly ( P ＜0.05 or P ＜0.01), pulmonary vascular thickening was alleviated and collagen fibers were reduced. The protein and gene expressions of SIRT1, FOXO3a, p27 and Caspase-3 were increased ( P ＜0.05 or P ＜0.01), while the protein and gene expressions of PCNA were decreased ( P ＜0.05 or P ＜0.01). Conclusion: Panax notoginseng saponins can relieve pulmonary vascular remodeling in rats with pulmonary hypertension by activating SIRT1/FOXO3a/p27 pathway.

Taking a typical lead-zinc mining area in Yangshuo county, Guangxi as the research object, the contents of 10 metal elements (Cr, Mn, Ni, Cu, Zn, As, Cd, Sb, Hg, and Pb) in the surface soil of Sidihe River basin in Yangshuo were analyzed and determined. Pearson correlation analysis, principal component analysis (PCA), positive definite matrix factorization (PMF), and other methods were comprehensively used to quantitatively analyze their contributions and identify pollution sources. In total, 168 surface soil samples were collected across the study area. The mean concentrations of Zn, Cd, Hg, and Pb in the soils were higher than the National Environmental Quality Standards for Soils in China. The mean contents of Sb, Cd, Cu, Pb, and Zn were higher than their corresponding local background values by approximately 1.01, 5.50, 3.29, 9.11, and 10.67 times, respectively, indicating that heavy metals have been enriched in topsoil. The I geo showed that the major pollutant element in the soils was Hg, followed by Pb, Zn, and Mn. Correlation analysis and principal component analysis showed that the sources of metal pollution in surface soil in the study area were complex and mainly from human activities. Cu, Zn, Cd, Sb, As, and Pb were mainly derived from mining activities; Hg, Cr, and Ni were controlled by soil parent material sources; and Mn and Cd were mainly derived from mining activities and agricultural activities. PMF model analysis results showed that the metal pollution sources in the surface soil were jointly affected by these three sources. Mining activities, natural sources, and a mixed source of mining activities and agricultural activities were the main sources of heavy metal pollution in the soils, accounting for 58.0%, 13.5%, and 28.6% of the total heavy metal accumulation, respectively. Ni, Cu, Zn, As, Sb, Hg, and Pb were derived mainly from mining activities. Cr, Ni, and Hg were mainly attributed to natural sources, such as soil parent materials and rainfall erosion (44.6%, 23.2%, and 21.0%, respectively), and Mn and Cd were associated with a mixed source of mining activities and agricultural activities (75.4% and 70.4%).

Objective: To explore the effect of three interventions including caloric restriction, rope-skipping exercise and caloric restriction combined with rope-skipping exercise on cardiometabolic risk factors in overweight or obese college students. Methods: This study was a pilot randomized controlled trial. Overweight or obese students who met the inclusion criteria were recruited at Sun Yat-sen University in September 2019 and were randomly divided into four groups: caloric restriction group (CR), rope-skipping group (RS), combined group (CR-RS) and control group (CT). The intervention in each group lasted 8 weeks, specifically: the daily energy intake of CR was 100% to 110% of the basal metabolic energy; RS was instructed to rope three times a week, and CR-RS combined caloric restriction with rope-skipping. At the baseline and end of 8-week intervention, basic information, anthropometric indicators and fasting vein blood of students were collected. Paired t test and Wilcoxon paired-samples signed rank test were used for comparison before and after intervention, and analysis of covariance was used for comparison between groups after intervention. Results: A total of 29 students completed the trial and were included in the final analysis (7, 9, 7 and 6 students in CR, RS, CR-RS and CT, respectively). The mean age of students were (19.00±1.00) years, including 11 males and 18 females. The baseline characteristics of four groups were comparable. After 8 weeks of intervention, compared with CT, there was an increase in the body fat percentage and fat mass index in CR and CR-RS ( P <0.05). Insulin level decreased in CR-RS ( P <0.05). Systolic blood pressure in CR and diastolic blood pressure in CR-RS were higher ( P <0.05). Compared with baseline, fat mass index decreased in CR ( P <0.05), while body weight, BMI, and fat mass index decreased in CR-RS ( P <0.05). Conclusion: It is suggested that the caloric restriction alone and calorie restriction combined with rope-skipping exercise can benefit overweight or obese college students with cardiometabolic risk factors.

An ultra-high performance liquid chromatography-tandem mass spectrometry(UHPLC-MS/MS) method was established for the determination of active components of Sarcandrae Herba, and applied to the pharmacokinetics study of multiple dosage forms. After SD rats were administered by gavage with three dosage forms [Sarcandrae Herba extract, commercial Sarcandrae Herba Guttate Pills, and polydopamine guttate pills loaded with active components of Sarcandrae Herba(PDA-Sg Guttate Pills)], blood samples were collected from the inner canthus at different time points. After protein precipitation, plasma samples were separated on ACQUITY UPLC C&#95;(18) column(2.1 mm×100 mm, 1.7 μm). The mobile phase consisted of water containing 0.2% formic acid and acetonitrile in gradient elution. The negative ions were measured simultaneously in the multi-reaction monitoring(MRM) mode. The pharmacokinetic parameters were calculated and fitted by DAS 2.0. All four components could be detected in the plasma of rats in each group at each time point except the neochlorogenic acid and cryptochlorogenic acid in the Sarcandrae Herba extract group. The guttate pills group showed a significant increase in drug content at each time point. The exposure of the main components of Sarcandrae Herba in blood was effectively increased by PDA-drug loading effect in PDA-Sg Guttate Pills(The AUC&#95;(0-24 h) of neochlorogenic acid, cryptochlorogenic acid, isaziridin and rosmarinic acid reached 2.45, 32.90, 1.54, 4.81 times that of the commercial guttate pills). This study proves the measurability of the above-mentioned multi-component in vitro-in vivo delivery process. The pharmacokinetic study has shown that PDA-Sg Guttate Pills can effectively delay the elimination time and improve the bioavailability of the four components, which can provide theoretical data for the production of the drug.

Objective: To explore the interventional mechanism of electroacupuncture (EA) of "Zusanli"(ST36)based on the involvement of mast cells/ transient receptor potential vanilloid type1 (TRPV1) signaling pathway in relieving visceral hypersensitivity in functional dyspepsia (FD) rats., Methods: Sixty SD rats (half male and half female, 10 days in age) were randomly divided into normal control, model, medication (ketotifen) and EA groups, with 15 rats in each group. The FD model was established by gavage of iodoacetamide combined with tail clamping (stress stimulation). Rats of the medication group received intraperitoneal injection of ketotifen (1 mg·kg -1 ·d -1 ) for 14 d, and those of the EA group received EA of ST36 for 20 min, once a day for 14 d. An air-balloon was inserted into the rat's stomach for recording changes of the intragastric pressure (mL/mm Hg) via a pressure transducer. The visceral hypersensitivity was assessed using abdominal withdrawal reflex (AWR) score and the number and degranulation of mast cells of gastric mucosa were observed using toluidine blue staining. The expression levels of TRPV1 and proteinase activated receptor 2 (PAR2) in the stomach were observed using immunofluorescence histochemistry and Western blot, separately, and the contents of SP and CGRP in the stomach detected using ELISA., Results: When the intragastric pressure was at 50, 60 and 70 mm Hg, the gastric compliance was significantly decreased ( P <0.01), and the levels of visceral sensitivity increased in the model group （ P <0.01）。 TRPV1 immunofluorescence tensity, expression of PAR2 and TRPV1 proteins, and contents of SP and CGRP in the stomach were considerably up-regulated in the model group compared with the normal control group ( P <0.01). In comparison with the model group, under intragastric pressure of 50，60 and 70 mm Hg, the gastric compliance was obviously increased, and the visceral hypersensitivity decreased in the EA group （ P <0.01, P <0.05）. TRPV1 immunofluorescence intensity, expression levels of PAR2 and TRPV1 proteins, and the contents of SP and CGRP in the stomach were considerably down-regulated in both medication and EA groups compared with the model group ( P <0.01, P <0.05). The therapeutic effect of EA was significantly superior to that of medication in up-regulating the gastric compliance （at 70 mm Hg）, and down-regulating the contents of SP and CGRP ( P <0.05). No significant differences were found between the EA and medication groups in up-regulating gastric compliance at intragastric pressure of 50 and 60 mm Hg, and in down-regulating the visceral sensitivity, TRPV1 fluorescence intensity, and expression of PAR2 and TRPV1 proteins ( P >0.05). Toluidine blue staining showed an apparent increase of mast cell number with obvious degranulation in the gastric mucosa of rats in the model group, which was milder in the EA and medication groups., Conclusion: EA of ST36 can suppress visceral hypersensitivity and increase the gastric compliance in FD rats, which may be related with its effects in inhibiting the activation of gastric mast cells, and down-regulating the expression of gastric PAR2 and TRPV1 proteins and SP and CGRP contents.

Objective: To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) on duodenal mast cells, nerve growth factor (NGF) and neurotrophic tyrosine kinase receptor type 1 (NTRK1), and to explore the mechanism of electroacupuncture at Zusanli (ST 36) on functional dyspepsia (FD)., Methods: Sixty SPF-grade 10-day-old SD rats were randomly divided into a normal group, a model group, a ketotifen group and an EA group, 15 rats in each group. The FD model was prepared by iodoacetamide combined with rat tail clamping method in the model group, the ketotifen group and the EA group. The rats in the ketotifen group were injected intraperitoneally with ketotifen (1 mg • kg -1 • d -1 ) for 7 days; the rats in the EA group were treated with EA at bilateral "Zusanli" (ST 36), with disperse-dense wave, frequency of 2 Hz/50 Hz and intensity of 0.5 mA, 20 min each time, once a day for 14 days. The gastric emptying rate and small intestinal propulsion rate in each group were observed; the morphology of duodenal mucosa was observed by HE staining; the toluidine blue staining was used to observe the number and degranulation of mast cells in duodenal mucosa; the protein and mRNA expressions of NGF, NTRK1 in duodenum were detected by Western blot and real-time PCR; the level of interleukin-1β (IL-1β) in duodenum was measured by ELISA., Results: Compared with the normal group, the gastric emptying rate and small intestinal propulsion rate in the model group were decreased ( P <0.01); compared with the model group, the gastric emptying rate and small intestinal propulsion rate in the ketotifen group and the EA group were increased ( P <0.01); the small intestinal propulsion rate in the EA group was higher than that in the ketotifen group ( P <0.01). In the model group, local defects in duodenal mucosa were observed with a small amount of inflammatory cell infiltration; no obvious abnormality was found in duodenal mucosa of the other groups. Compared with the normal group, the mast cells of duodenal mucosa in the model group were increased significantly with significant degranulation; compared with the model group, the mast cells of duodenal mucosa in the ketotifen group and the EA group were decreased significantly, and the degranulation was not obvious. Compared with the normal group, the protein and mRNA expressions of NGF, NTRK1 as well as the level of IL-1β in duodenum in the model group were increased ( P <0.01); compared with the model group, the protein and mRNA expressions of NGF, NTRK1 as well as the levels of IL-1β in duodenum in the ketotifen group and the EA group were decreased ( P <0.01, P <0.05); compared with the ketotifen group, the mRNA expression of NGF, as well as the protein and mRNA expressions of NTRK1 in duodenum in the EA group were decreased ( P <0.05, P <0.01)., Conclusion: EA at "Zusanli" (ST 36) could inhibit the activation of duodenal mast cells and regulate the expressions of NGF and its receptor to improve the low-grade inflammatory response of duodenum, resulting in treatment effect on FD.

The purpose of this paper was to study the transcriptional regulation of nuclear respiratory factor 1 (NRF1) on nuclear factor kappa B (NF-κB), a key molecule in lipopolysaccharide (LPS)-induced lung epithelial inflammation, and to clarify the mechanism of NRF1-mediated inflammatory response in lung epithelial cells. In vivo, male BALB/c mice were treated with NRF1 siRNA, followed with LPS (4 mg/kg) or 0.9% saline through respiratory tract, and sacrificed 48 h later. Expression levels of NRF1, NF-κB p65 and its target genes were detected by Western blot and real-time PCR. Nuclear translocation of NRF1 or p65 was measured by immunofluorescent technique. In vitro, L132 cells were transfected with NRF1 siRNA or treated with BAY 11-7082 (5 μmol/L) for 24 h, followed with treatment of 1 mg/L LPS for 6 h. Cells were lysed for detections of NRF1, NF-κB p65 and its target genes as well as the binding sites of NRF1 on RELA (encoding NF-κB p65) promoter by chromatin immunoprecipitation assay (ChIP). Results showed that LPS stimulated NRF1 and NF-κB p65. Pro-inflammatory factors including interleukin-1β (IL-1β) and IL-6 were significantly increased both in vivo and in vitro. Obvious nuclear translocations of NRF1 and p65 were observed in LPS-stimulated lung tissue. Silencing NRF1 resulted in a decrease of p65 and its target genes both in vivo and in vitro. In addition, BAY 11-7082, an inhibitor of NF-κB, significantly repressed the inflammatory responses induced by LPS without affecting NRF1 expression. Furthermore, it was proved that NRF1 had three binding sites on RELA promoter region. In summary, NRF1 is involved in LPS-mediated acute lung injury through the transcriptional regulation on NF-κB p65.

Autoimmune disease is a disease caused by the body's immune system being misdirected to attack the host itself. Patients with this type of diseases are in poor general condition, and are affected by vascular and skin tissue lesions, and therapeutic drugs. Once the skin is broken, chronic wounds that do not heal could easily develop. This type of wounds is difficult to treat and requires joint diagnosis and treatment of multidisciplinary physicians. Therefore, this article reviews the advances on research and treatment of autoimmune disease-related chronic wounds in order to provide reference for their clinical treatment.

Critical ultrasonography is widely used in ICU and has become an indispensable tool for clinicians. However, besides operator-dependency of critical ultrasonography, lack of standardized training mainly result in the physicians' heterogenous ultrasonic skill. Therefore, standardized training as well as strict quality control plays the key role in the development of critical ultrasonography. We present this quality control standards to promote better development of critical ultrasonography.

Objective: To explore the risk factors and prognosis of sepsis-related cardiomyopathy. Methods: Patients with sepsis and septic shock admitted to the Critical Care Medicine Department at Peking Union Medical College Hospital from October 2017 to February 2021 were enrolled. Echocardiographic parameters including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and cardiac index (CI) were obtained within 24 h after admission. Hemodynamic parameters including heart rate, mean arterial pressure and central venous pressure were also collected. The risk factors of 45-day mortality were analyzed using Cox regression analysis. Kaplan-Meier survival analysis was performed to compare 45-day mortality among patients with normal left ventricle (LV) systolic function group, sepsis-related takotsubo cardiomyopathy (ST) and septic cardiomyopathy (SC) group as well as between patients with normal right ventricular (RV) function and patients with RV dysfunction. Results: According to LV systolic function, patients were categorized into three groups: normal group [174 (66.9%)], SC group [66 (25.4%)] and ST group [66 (25.4%)]. In comparison with those in normal group, patients in SC group and ST group had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score ( P <0.05). No difference was found between SC group and ST group regarding APACHE Ⅱ score and SOFA score( P >0.05). ST group had lower LVEF [33(28, 41)% vs. 45(38, 48)%, P <0.05], CI [2.29 (1.99, 2.53)L·min -1 ·m -2 vs. 3.04(2.61, 3.61) L·min -1 ·m -2 , P <0.05] higher TAPSE [18.6(16.0, 21.2)mm vs. 15.1(12.5, 19.0)mm, P <0.05] than SC group. A Cox regression survival analysis showed that right ventricular dysfunction (RVD) was an independent predictor of 45-day mortality ( HR =1.992, 95% CI 1.088-3.647, P =0.025). A Kaplan-Meier analysis revealed no significant difference regarding 45-day mortality among ST group [25.0%(5/20)], SC group [30.3%(20/66)] and normal group 18.4%(32/174)( P =0.158). RVD patients [38.0%(30/79)] had significantly higher 45-day mortality than patients with normal RV function [14.9%(27/181), P <0.001]. Conclusions: In comparison with SC patients, ST patients tend to have worse LV systolic function, lower cardiac output and better RV function. However, neither ST nor SC is associated with 45-day mortality. RVD is a risk predictor of 45-day mortality, which should be monitored in septic patients.

The spatial pattern of plant population is one of primary issues in ecological research. Point pattern analy-sis is considered as an important method to study the spatial pattern of plant population. Ripley's K function has been commonly used for point pattern analysis. However, the cumulative effect of Ripley's K function may lead to specific spatial pattern charcteristics. To explore how the cumulative effect of Ripley's K function affects population pattern, the data of clumped distribution, random distribution and regular distribution of Stipa grandis were simulated by R software. All data generated by R software were analyzed by Ripley's K function and the non-cumulative pairwise correlation function g ( r ). The results showed that for clumped distribution (or regular distribution), the cumulative effect of Ripley's K function was manifested in two aspects. On the one hand, the scale of clumped distribution (or regular distribution) was increased due to Ripley's K function. On the other hand, Ripley's K function could detect the difference of the distribution of cluster (or negative interaction range) in the sampling space, exhibiting different pattern characteristics. For random distribution, Ripley's K function had no cumulative effect. In conclusion, the combination of Ripley's K function and pairwise correlation function by collecting replicate samples could better reveal the essential characteristics of the pattern in the study of population pattern.

Objective: To investigate the role of operative link on gastritis assessment (OLGA) staging system in risk assessment of gastric precancerous states and precancerous lesions. Methods: A total of 682 patients undergoing gastroscopy from January to July 2016 at the First Hospital of Jiaxing were enrolled. According to the results of gastroscopy and pathology, patients were divided into five groups by OLGA staging system, respectively. The differences of atrophic progression/reversion rate, detection rates of intraepithelial neoplasia and gastric cancer among different OLGA groups during 5-year follow-up were compared. Results: A total of 437 patients completed endoscopic follow-up, including 207 cases in Stage-0, 158 cases in Stage-Ⅰ, 47 cases in Stage-Ⅱ, 18 cases in Stage-Ⅲ and 7 cases in Stage-Ⅳ. There were 24 cases of atrophy progression, 78 cases of atrophy reversion, 5 cases of intraepithelial neoplasia and 2 cases of gastric cancer. The atrophy progression rate correlated with the rising OLGA stages(χ 2 =19.14, P< 0.001);The rate of atrophy reversion in high-risk group was significantly lower than that in low-risk group(χ 2 =4.96, P= 0.026); The detection rate of intraepithelial neoplasia and gastric cancer in high-risk group was significantly higher than that in low-risk group(χ 2 =29.63, 11.60, both P< 0.05). Conclusions: Histological OLGA staging system is helpful to realize the risk stratification assessment of gastric precancerous states and precancerous lesions. It has practical significance to formulate individualized endoscopic/histological follow-up plan for OLGA high-risk group.

Objective: To investigate the liver injury induced by lung ischemia / reperfusion(LI/R) and the role of autophagy in its prevention and treatment. Methods: The lung ischemia/reperfusion injury(LI/RI) model was prepared by anesthetizing the rats, cutting the trachea for mechanical ventilation, and using an arterial clamp to close the pulmonary hilum to simulate the ischemic process, and releasing the arterial clamp after 30 min to resume perfusion for 3 h. SD rats( n =24)were randomly divided into sham operation(sham)group,ischemia/reperfusion(I/R)group,solvent(DMSO)group and autophagy inhibitor (3-MA) group, 6 rats in each group. The rats were intraperitoneally injected with medicine before operation. After the rat LI/RI model was established,the rats were killed, and the lung wet/dry weight ratio was used to evaluate the success of modeling, the venous blood was collected to measure the contents of ALT and AST, and the liver tissues were collected. Light and electron microscopes were used to observed the liver tissues and cell shapes. The protein and mRNA expression levels of autophagy related proteins were determined by Western blot and RT-qPCR to suggest autophagy levels. Results: Compared with sham group, the lung wet/dry weight ratios in other groups were elevated, and the liver tissues of other groups were damaged significantly. Serum levels of AST and ALT were increased significantly and liver tissue damage was obvious, especially in I/R group. The light microscopy showed that the arrangement of hepatic cords was disordered or broken, hepatic sinuses were dilated, and edema of liver cells were observed; transmission electron microscopy showed varying degrees of mitochondria swelling up in liver cells in the other groups. At the same time, the expressions of AMPK, Beclin 1 and LC3 mRNA were increased, but the expressions of mTOR and p62 mRNA were decreased; the protein expressions of p-AMPK, Beclin 1, LC3-B were increased significantly, but those of p-mTOR and p62 were decreased (all P ＜0.05). Compared with DMSO group, the injury of liver tissue in 3-MA group was alleviated, the damage degree of mitochondrial ultrastructure was lower, the levels of AST and ALT were decreased, the transcription and protein expression levels of autophagy related protein in liver tissue were decreased ( P ＜0.05). However, the injury degree of IR and DMSO groups were similar, and there was no significant differences in each index ( P ＞0.05). Conclusion: Lung ischemia/reperfusion can cause liver injury in rats. Autophagy can mediate liver injury induced by lung ischemia / reperfusion in rats and inhibiting autophagy can effectively reduce liver injury induced by LI/R in rats.

Improving the green development efficiency of the three major urban agglomerations in Zhejiang is an important way to faster build the pilot demonstration area of beautiful China. Based on county panel data from 2000 to 2019 of 41 counties (cities) included in the three major urban agglomerations, we combined the super-efficiency SBM model with window analysis to evaluate the efficiency, and used spatial econometric analysis method to study the spatial distribution and the differences in regional difference. Furthermore, the fixed panel fixed effect model was used to explore the differential influencing mechanism. The results showed that green development efficiency of the three major urban agglomerations increased gradually with fluctuations during the study period. The distribution of efficiency values gradually shifted from a situation of 'high in the north and low in the south' to a 'relatively common and coordinated' development in the various regions. There was a significant spatial agglomeration effect in green development efficiency of the three major urban agglomerations, but it presented fluctuating phenomenon among cities which were at the similar level. The average green development efficiency of central Zhejiang urban agglomeration was the highest. The development within the three major urban agglomerations was relatively stable. The annulus Hangzhou Bay urban agglomeration came next, with stable development. The Wenzhou-Taizhou coastal urban agglomeration was the lowest, but the efficiency enhancement was the largest. The increases in population density, along with the proportion of added value of tertiary industry in GDP, per capita industrial added value, local fiscal expenditures, education expenditures and per capita actual use of foreign capital could improve the efficiency of green development. However, the increases in industrial electricity consumption and fixed asset investment in kennels would inhibit the improvement of green development efficiency. The impacts of per capita industrial added value, local fiscal expenditure, education expenditure and per capita actual use of foreign capital on urban agglomerations were heterogeneous among different cities.

Objective: To investigate the clinicopathological features, immunophenotype, ultrastructure, genetic alterations and prognosis of succinate dehydrogenase-deficient renal cell carcinoma (SDH RCC). Methods: A total of 11 SDH RCCs, diagnosed from 2010 to 2019, were selected from the Department of Pathology of Nanjing Jingling Hospital, Nanjing University School of Medicine for clinicopathologic, immunohistochemical (IHC), ultrastructural investigation and follow-up. The molecular features of seven cases were analyzed by the panel-targeted DNA next generation sequencing (NGS). Results: There were seven males and four females, with ages ranging from 24 to 62 years (mean 41.4 years, median 41 years). Microscopically, SDH RCC was mainly composed of solid and tubular structures with local cystic change. Four cases showed nested or trabecular structure distributed in a loose hypocellular connective tissue or around scar, similar to oncocytoma. The neoplastic cells demonstrated flocculent eosinophilic cytoplasm with typical intracytoplasmic vacuoles. Immunohistochemically, eight cases were negative for SDHB; three cases showed focal and weak expression, whereas normal renal tubular and vascular endothelial cells demonstrated strong cytoplasmic staining. NGS of DNA targeted-panel detected pathogenic mutations of SDHB gene in seven cases (including three cases with equivocal IHC expression of SDHB), without any mutations in other SDH related genes. There were four cases of SDHB missense mutation, one case of frameshift mutation, one case of splicing mutation, and one case of acquired stop codon mutation. Conclusions: SDH RCC is a distinct variant of RCCs with genetic tendency or with hereditary cancer syndrome. NGS is recommended to detect the related gene mutations for a definitive diagnosis. The patients should be closely followed up.

Objective: To study the clinical pathological characteristics, immunophenotype, molecular changes and prognosis of the papillary renal neoplasm with reverse polarity (PRNRP). Methods: Nine cases of PRNRP, diagnosed from 2013 to 2019, were retrieved from the Department of Pathology of Nanjing Jinling Hospital, Nanjing University School of Medicine. Histomorphology, immunophenotype and molecular genetics were analyzed with review of the literatures. Results: There were five male and four female patients, aged from 49 to 70 years, with an average age of 60.1 years. During a mean follow-up of 29 months, one patient died for other cause, and the others survived without disease. Microscopically, the tumor cells arranged in papillary structure with a fibrovascular core, the surface of which was covered with a single layer of cuboidal or columnar cells. The most prominent feature was that the tumor nuclei located at the top of the cytoplasm far from the basement membrane, and they were monotonous in size and arranged neatly with no or few nucleoli. Immunohistochemically, all nine cases of PRNRP showed diffuse positive expression of CK7 and E-cadherin, various degrees of P504s expression, and no expression of CD10 and CD117, with a Ki-67 index of 1%-3%. Unlike other papillary renal cell carcinoma, the nine cases of PRNRP all showed characteristic positive expression of GATA3. The fluorescence in situ hybridization assay showed that the majority of PRNRPs (8/9) did not have triploids on chromosomes 7 and 17. The sequencing of the KRAS gene confirmed the presence of a nonsense KRAS mutation in 8 of the 9 cases. Conclusions: PRNRP is a subtype of papillary renal cell carcinoma with characteristic morphological, immunophenotypic and molecular features, and indolent behaviors. More data are needed to define PRNRP as "carcinoma", and a definitive diagnosis of PRNRP is of great significance for proper treatment choice and accurate prognostication.

Objective: To investigate the clinicopathological features, molecular characteristics, differential diagnosis and prognosis of anaplastic lymphoma kinase (ALK)-translocation renal cell carcinoma. Methods: Two cases of ALK-translocation renal cell carcinoma diagnosed from January 2011 to December 2020 were retrospectively analyzed to characterize their morphological features, immunohistochemical expression and prognosis. Multiple molecular studies including fluorescence in situ hybridization (FISH), reverse transcriptase-polymerase chain reaction (RT-PCR), and next-generation sequencing were performed to characterize the genetic alterations. Results: Two patients included one male and one female, with 59 and 57 years old, respectively. Morphologically, case 1 resembled collecting duct carcinoma or renal medullary carcinoma, which demonstrated tubular, microcapsule and reticular structures, with a remarkable myxoid background and lymphocytes infiltration; case 2 resembled Xp11.2 translocation renal cell carcinoma or type 2 papillary renal cell carcinoma, which demonstrated tubular papillary and focal solid structures, with flocculent cytoplasm and many foamy histiocytes, but without myxoid background and lymphocytes infiltration. Immunohistochemistry showed strongly positive expression of ALK. CK7, E-cadherin, vimentin, PAX8 and CD10 showed various degrees of expression, and other antibodies were nonreactive. A variety of molecular assays showed definite ALK gene translocation, with rare VCL-ALK gene fusion (VCL exon and 16-ALK exon 20) in case 1, and EML4-ALK gene fusion (EML4 exon and 2-ALK exon 20) in case 2. Conclusions: ALK-translocation renal cell carcinoma is rare with various morphological features, and is easy to miss and misdiagnose. The characteristic ALK expression and molecular detection of ALK translocation are helpful for diagnosing this type of renal cell carcinoma.

Biological nitrogen (N) fixation and organic N degradation are the main sources of soil available N, while microorganisms driving such processes play an important role in soil N supply and the maintenance of soil fertility. In this study, real-time quantitative PCR and amplicon sequencing technology were used to examine the effects of restoration types on the community structure of N 2 -fixing and chitin-degrading bacteria harboring nifH and chiA genes, respectively, and the gene abundance under four meadows (undisturbed, grazing, fencing, and fencing + reseeding mea-dows) in Qinghai-Tibet Plateau. The results showed that the abundance of nifH and chiA in the four meadows followed the order of undisturbed meadow > grazed meadow > fencing meadow > fencing + reseeding meadow. The abundance of nifH and chiA in the undisturbed meadow was 3.4-6.3 times and 3.3-8.3 times of that in the other three meadows. The α diversity of N 2 -fixing bacteria in gra-zing, fencing, and fencing + reseeding meadows was significantly higher than that in the undisturbed meadow, while the α diversity of chitin-degrading bacteria was higher in the undisturbed and grazing meadows. Grazing significantly increased the relative abundance of Proteobacteria, but decreased the relative abundance of Cyanobacteria and Actinobacteria. The abundance of nifH and chiA was significantly affected by soil moisture, nutrients, and vegetation characteristics, while the community structure of nifH and chiA was affected by soil moisture, soil organic carbon content, and soil pH. Compared with undisturbed meadow, grazing reduced the potential of N fixation and organic N degradation.The improvement of 10 years grazing prohibition with fencing and reseeding measures on the function of N fixation and organic N degradation was not obvious. The characteristics of functional microbes and their influencing factors should be comprehensively considered during meadow restoration, which might take longer time or take reasonable management measures to restore grazing meadow to undisturbed level.

Objective: To analyze the pathogenic bacteria and epidemiological characteristics in children with respiratory tract infection in Tianjin area. Methods: Retrospective case analysis was performed on 2 392 hospitalized children in the wards of respiratory diseases, intensive care unit and special care ward of Tianjin Children's Hospital from June 2018 to May 2019. Thirteen pathogenic bacteria in deep sputum and bronchoalveolar lavage fluid samples were detected by loop-mediated isothermal amplification. The laboratory data and clinical characteristics of the infected children were analyzed, and the comparison between groups was performed by t test or χ 2 test. Results: Among 2 392 cases, 1 407 were males and 985 females. There was no significant difference in the detection rate between males and females (72.5% (1 020/1 407) vs .74.2% (731/985), χ 2 =0.87, P =0.35). A total of 1 751 strains and 12 kinds of positive respiratory pathogens were detected, with a detection rate of 73.2%. Among them, 913 (38.2%) strains were Mycoplasma pneumoniae (MP), 514 (21.5%) were Streptococcus pneumoniae (Sp), 381 (15.9%) were Methicillin-resistant Staphylococcus aureus (MRSA) and 279 (11.7%) were Hemophilus influenzae (Hi). There was significant difference in the detection rate of pathogens among different age groups (χ²=83.67, P< 0.01). The positive rate of alveolar lavage fluid group was higher than that of deep sputum fluid group [81.6% (614/752) vs. 69.3% (1 137/1 640), χ 2 =39.89, P <0.01]. The length of hospital stay of children infected with different pathogens was significantly different (all P <0.01). There was significant difference in duration of fever among children infected with different pathogens (χ²=228.69,103.56, 3.96, 27.38,24.50,41.66, all P <0.05). There were 63 (7.7%) cases of atelectasis, 260 (31.9%) cases of pleurisy and 120 (14.7%) cases of pleural effusion in MP children. Children with Sma were most likely to involve the heart system (2/9), and children with Eco infection had a higher incidence of complications such as those of blood (3/19), urinary (2/19), digestive systems(4/19), systemic inflammatory response syndrome and sepsis (1/19). Conclusions: The main bacterial pathogens of respiratory tract infection in children in Tianjin were MP, Sp, MRSA and Hi. It is suggested that clinicians should not only pay attention to the respiratory symptoms of children, but also pay attention to the complications caused by bacterial pathogen infection, so as to prevent the deterioration of the disease and improve the prognosis.

Fungi are important drivers of soil biogeochemical cycles. However, the characteristics of fungal community structures and functional groups within karst area (KA) soils remain understudied. Top soil samples were collected from paddy fields within a KA and non-karst area (NKA) containing red soil, in the Maocun karst experimental site of Guilin. The fungal community structure was analyzed via high-throughput sequencing, and FUNGuild was used to predict the function of fungi. The average relative abundance of Mucormycota in KA was 4.87%, which was significantly lower than that in NKA (29.92%); The average relative abundance of Mortierellomycetes in KA was 3.36%, which was significantly lower than that in NKA (29.15%). However, in KA, the average relative abundances of Glomeromycetes, Chytridiomycetes, and Exobasidiomycetes were 0.91%, 0.98%, and 0.23%, respectively, significantly higher than those in NKA (0.47%, 0.28%, and 0.04%). In KA, the average relative abundances of Ramophialophora and Emericellopsis were 2.39% and 1.25%, respectively, significantly higher than those in NKA (0.05% and 0.09%). However, the average relative abundance of Mortierella was 3.04% in KA, which was lower than that in NKA (28.34%). KA contained 32 dominant OTUs, including OTU141, 99, and 192. There was more connectivity between OTU69 ( Emericellopsis terricola ) and OTU138 ( Westerdykella globosa ) with the cation exchange capacity (CEC), exchangeable Ca 2+ , and total phosphorus (TP) in the correlation network. In KA, the average abundances of symbiotroph and pathotroph-saprotroph fungi were 1.29% and 1.50%, respectively, significantly higher than those in NKA (0.08% and 0.09%). The average abundance of the saprotroph-symbiotroph fungi in KA was 10.81%, which was significantly lower than that in NKA (63.69%). In KA, dung saprotroph-wood saprotroph fungi were dominant, with an abundance of 9.73%, whereas in NKA, endophyte-litter saprotroph-soil saprotroph-undefined saprotroph fungi were dominant, with an abundance of 45.93%. The above results suggest that the soil factors of KA, such as CEC, exchangeable Ca 2+ , and TP, alter the structures and functions of fungi.

Objective: To understand the hazard degree of respirable dust (exhaled dust) in coal mine underground workplaces in China, and to provide reference for the prevention and treatment of pneumoconiosis. Methods: A total of 98 representative coal mines were selected from 2016 to 2018, and the dust concentration of the underground working face was detected by the methods of on-the-spot investigation and on-the-spot detection, the dust control measures of 29 coal mines were investigated, and the hazard degree of dust exhaling in the underground working place was analyzed statistically. Results: All 1238 samples of individual coal dust (exhaled dust) were detected in 98 underground coal mines, and the concentration was 4.0 (2.2, 7.3) mg/m(3), the over-standard rate was 73.3% (908/1238) . The concentration of coal dust (exhaled dust) in coal mining face was 5.4 (3.0, 10.6) mg/m(3), and the concentration of coal dust (exhaled dust) in heading face was 3.7 (2.1, 7.2) mg/m(3). The concentration exceeding standard rate of coal dust (exhaled dust) in coal mining face was higher than that in heading face, and the difference was statistically significant ( P <0.05) . Coal seam water injection was found in 57.7% (15/26) coal mining face and 42.9% (9/21) heading face in the application of dust control measures, and the high pressure spray of shearer roadheader only accounted for 38.5% (10/26) and 28.6% (6/21) . Conclusion: The concentration of coal dust (exhaled dust) in the underground face of coal mine is seriously exceeding the standard, and the dust prevention measures have not been put in place.Compulsory standards for classified management of dust in underground coal mines should be formulated, and the research and implementation of dust control technologies should be strengthened.

In order to clarify the characteristics of anaerobic ammonia oxidizing (ANAMMOX) sludge and the succession rule of bacteria based on particle size differentiation, the performance change and microbial community structure of ANAMMOX floc sludge during the formation of particles in the reaction system of a high ammonia-nitrogen biofilter were studied. The results indicated that the specific activity (SAA) and tolerance of the ANAMMOX granular sludge (AnGS) were significantly improved by increasing the particle size, and the SAA of R4(>4.75 mm) was up to 426.8 mg·(g·d) -1 , but it also had adverse effects on mass transfer. The results of the high-throughput sequencing showed that dynamic changes between bacterial genera were common. When the particle size was less than 4.75 mm, the increase in particle size strengthened the stability of the bacterial flora, the ammonia oxidizing bacteria (AOB) with more flocs were eliminated, and the nitrogen removal ratio gradually stabilized. R3 (2.8-4.75 mm) exhibited the most specific flora composition, and the functional bacteria Candidatus Kuenenia accounted for 52.7%, while the R4 community complexity increased. Furthermore, the proportion of functional bacteria decreased, and the abundance of heterotrophic bacteria increased, which negatively affected the particle structure. In addition, the R3 microorganism has the best gene function expression level, which is significantly better than small particles in gene replication repair and energy conversion. Finally, the evolution of AnGS was analyzed through the OTU matrix between the samples. These results have some guiding significance for the optimization of the AnGS system and will be helpful for the application of the ANAMMOX process.